Restraints

The use of restraints is an issue with large ethical as well as practical considerations. The Joint Commission has strict rules about their use, and in my facility we simply don't use them. The issues surrounding documentation don't exist for us, because we don't even own them. I suppose someone could make something out of rolled gauze, but they would be facing termination if they did.

So the question becomes, how do we control people who are out of control? First and foremost, we try to find the reason for the agitation. If this is a dementia patient, we try to meet their needs. If they need to walk, we find a staff member who can walk with them. If there is a toileting need, we help take care of that. We do use medications, from benzodiazepines to anti psychotics, which is a form of chemical restraint. We have also gone so far as to put the mattress on the floor to keep people from falling out of bed.

It's clear that tying people down makes the agitation worse, and is cruel and demeaning. Some may say that chemical restraint is just as bad, but I don't think so, because the person is still able to move about and interact. I try to give only as much as is needed for symptom control, not to render them completely helpless.

We're fortunate in my facility to have a staff/patient ratio of 3/8, and if the need arises for a 1/1 sitter that can be arranged. We are committed to never needing to restrain our patients, but to maintain their safety in other more creative ways. I'm interested in how others manage this problem.